daily diary: hvad system

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Daily Diary: HVAD System

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Page 1: Daily Diary: HVAD System

© 2016 HeartWare, Inc. GL1226 Rev01 04/16

Driveline Exit Site ExamCheck the exit site for signs of infection as part of every dressing change.Record the site score (1-3) in the diary.

1. Normal exit site2. Superficial infection3. Deep infection

HeartWare, Inc.14400 NW 60th Avenue

Miami Lakes, FL 33014 USA www.heartware.com

HEARTWARE, HVAD, and the HEARTWARE logo are trademarks of HeartWare, Inc.

CAUTION: Federal law (USA) restricts this device to sale by or on the order of a physician. Refer to the “Instructions for Use” for complete Indications for Use, Contraindications, Warnings, Precautions, Adverse Events and Instructions prior to using this device. The IFU can be found at www.heartware.com/clinicians/instructions-use.

Normal driveline exit site:No erythema, tenderness or drainage. Well incorporated.

ü

Superficial infection:Purulent discharge and erythema spreading around the exit site.

ü

Deep infection:Localized pain, erythema, abscess deep to the incision around the driveline.

ü

Daily Diary: HVAD System

Page 2: Daily Diary: HVAD System

Reminder: Please bring your diary with you to each regular clinic visit!

The HVAD System is a continuous flow device. This means there may be a narrow pulse pressure, which can make it difficult to obtain a blood pressure. The VAD Team will discuss with you the best way to obtain your blood pressure.

1. If you have a palpable radial pulse, a blood pressure cuff will beused to obtain the measurements that you should write down inthe diary as SBP and DBP.

2. If you do not have a palpable radial pulse, a doppler and bloodpressure cuff will be used to obtain the measurements that youshould write down in the diary as doppler pressure.

It is important to manage and monitor your physical and LVAD parameters carefully while you have

the HVAD® System implanted.

Patient Information

Name:

Phone:

Date of implant:

Hospital Information

Name:

Physician:

Phone number:

VAD team / contact person:

Phone number:

Next Appointments

Date & time:

Date & time:

Date & time:

The VAD team recommendations are (e.g. INR, blood pressure, dressing changes):

Call your VAD team when:

Page 3: Daily Diary: HVAD System

Physical Parameters LVAD Parameters Additional Remarks

Blood Pressure INR Weight Exit Site Flow Speed Power AlarmsPlease record any abnormalities

you are realizing e.g. body temperature, exit site, change in health, pain,

system components, alarm details, etc.Date Time (AM/PM) SBP DBP Doppler

Pressure Lbs/kg Status 1 to 3 L/min RPM Watts Y/N

Page 4: Daily Diary: HVAD System

Physical Parameters LVAD Parameters Additional Remarks

Blood Pressure INR Weight Exit Site Flow Speed Power AlarmsPlease record any abnormalities

you are realizing e.g. body temperature, exit site, change in health, pain,

system components, alarm details, etc.Date Time (AM/PM) SBP DBP Doppler

Pressure Lbs/kg Status 1 to 3 L/min RPM Watts Y/N

Page 5: Daily Diary: HVAD System

Physical Parameters LVAD Parameters Additional Remarks

Blood Pressure INR Weight Exit Site Flow Speed Power AlarmsPlease record any abnormalities

you are realizing e.g. body temperature, exit site, change in health, pain,

system components, alarm details, etc.Date Time (AM/PM) SBP DBP Doppler

Pressure Lbs/kg Status 1 to 3 L/min RPM Watts Y/N

Page 6: Daily Diary: HVAD System

Physical Parameters LVAD Parameters Additional Remarks

Blood Pressure INR Weight Exit Site Flow Speed Power AlarmsPlease record any abnormalities

you are realizing e.g. body temperature, exit site, change in health, pain,

system components, alarm details, etc.Date Time (AM/PM) SBP DBP Doppler

Pressure Lbs/kg Status 1 to 3 L/min RPM Watts Y/N

Page 7: Daily Diary: HVAD System

Physical Parameters LVAD Parameters Additional Remarks

Blood Pressure INR Weight Exit Site Flow Speed Power AlarmsPlease record any abnormalities

you are realizing e.g. body temperature, exit site, change in health, pain,

system components, alarm details, etc.Date Time (AM/PM) SBP DBP Doppler

Pressure Lbs/kg Status 1 to 3 L/min RPM Watts Y/N

Page 8: Daily Diary: HVAD System

Physical Parameters LVAD Parameters Additional Remarks

Blood Pressure INR Weight Exit Site Flow Speed Power AlarmsPlease record any abnormalities

you are realizing e.g. body temperature, exit site, change in health, pain,

system components, alarm details, etc.Date Time (AM/PM) SBP DBP Doppler

Pressure Lbs/kg Status 1 to 3 L/min RPM Watts Y/N

Page 9: Daily Diary: HVAD System

© 2016 HeartWare, Inc. GL1226 Rev01 04/16

Driveline Exit Site ExamCheck the exit site for signs of infection as part of every dressing change.Record the site score (1-3) in the diary.

1. Normal exit site2. Superficial infection3. Deep infection

HeartWare, Inc.14400 NW 60th Avenue

Miami Lakes, FL 33014 USA www.heartware.com

HEARTWARE, HVAD, and the HEARTWARE logo are trademarks of HeartWare, Inc.

CAUTION: Federal law (USA) restricts this device to sale by or on the order of a physician. Refer to the “Instructions for Use” for complete Indications for Use, Contraindications, Warnings, Precautions, Adverse Events and Instructions prior to using this device. The IFU can be found at www.heartware.com/clinicians/instructions-use.

Normal driveline exit site:No erythema, tenderness or drainage. Well incorporated.

ü

Superficial infection:Purulent discharge and erythema spreading around the exit site.

ü

Deep infection:Localized pain, erythema, abscess deep to the incision around the driveline.

ü

Daily Diary: HVAD System